Lateral Extra-Articular Tenodesis (LET / Lemaire)

⚙️What This Procedure Involves

Through an incision on the outer knee, a strip of the iliotibial band (leaving it attached distally) is passed deep to the lateral collateral ligament, through a tunnel in the lateral femoral epicondyle, and sutured back to itself. This creates a lateral checkrein that resists tibial internal rotation — the component of instability responsible for the pivot shift. It is always performed in addition to ACL reconstruction, not instead of it. Adds approximately 20 minutes to the ACL operation.

💡Why It May Be Recommended

LET is recommended alongside ACL reconstruction for patients at high risk of re-rupture: those under 25 returning to pivoting sports, revision ACL reconstruction, high-grade pivot shift, and patients with radiographic signs of lateral instability (Segond fracture, lateral capsular sign).

⚖️Non-Operative Alternatives

Standard ACL reconstruction without LET is appropriate for most patients. LET is specifically for high-risk groups.

📋Preparing for Surgery

Same as ACL reconstruction. Assessment of pivot shift grade. Risk factor assessment.

✅Expected Benefits

The STABILITY trial showed that adding LET to hamstring ACL reconstruction reduced graft rupture from 11% to 4% in young athletes. It significantly improves rotational control.

⚠️Common Risks

• Lateral knee stiffnessUncommon

  Mild restriction of deep flexion possible but uncommon with modern technique.

• Lateral numbnessCommon

  From skin incision near lateral cutaneous nerves.

🔴Less Common but Serious Risks

• Over-constraintRare

  If tensioned too tightly. Modern techniques minimise this risk.

• ITB irritationUncommon

  At the harvest or rerouting site.

• InfectionRare

  Joint infection.

💉Anaesthetic Considerations

Same as ACL reconstruction — general or spinal with nerve block.

🏃Recovery and Rehabilitation

Same protocol as ACL reconstruction. No additional restrictions. Running at four to six months. Sport at nine to twelve months.

📅Follow-Up

Same as ACL reconstruction.

❓Frequently Asked Questions